Accessory nerve pasly and long thoracic nerve palsy are common causes of a winged scapula. This study was designed to examine the three-dimensional movement of the scapula in them.
Six accessory nerve palsy patients and five long thoracic nerve palsy patients were examined.
The active arm elevation was allowed in both the sagittal and scapular planes. Eight points were determined as marking points of the spine, the sternum, the clavicle, the scapula and the humerus which were identified every thirty degrees. These were recorded on three VCRs. A threedimensional analysis system (ARIELTM) was employed. The affected and unaffected sides were measured before and after therapy, when possible.
In patients with accessory nerve palsy, the scapula (glenoid cavity) rotated downward (the downward rotation) in the early phase of arm elevation in the scapular plane. At the same time, the subscapular fossa tilted upward (the upward tilt) and the subscapular fossa tilted medially. In patients with long thoracic nerve palsy, on the other hand, the downward rotation and the upward tilt of the scapula were marked by a forward flexion. When the paralysis was restored, the scapular movement changed to a similar pattern to that of the unaffected side. This method is useful for the quantitative evaluation of the abnormality and the improvement of accessory nerve palsy and long thoracic nerve palsy.
